Probably over 250,000 men suffered from ‘shell shock’ as result of the First World War. Shell shock is a term coined in World War I by British psychologist Charles Samuel Myers to describe the type of post traumatic stress disorder many soldiers were afflicted with during the war (before PTSD was termed). It is a reaction to the intensity of the bombardment and fighting that produced a helplessness appearing variously as panic and being scared, flight, or an inability to reason, sleep, walk or talk.
During the war, the concept of shell shock was ill-defined. A case of “shell shock” can be interpreted as physical or mental injury, or simply a lack of moral toughness.The term shell shock is used by the U.S. Department of Veterans Although it is still used to describe the , it is mostly remembered and is often recognized as the hallmark damage of war.
In World War II and thereafter, diagnosis of “shell shock” was replaced by that of combat stress reaction, a similar but not identical response to the trauma of warfare and bombardment.
Origin: What caused shell shock?
During the early stages of World War I in 1914, soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise. While these symptoms resembled those that would be expected after a physical wound to the brain, many of those reporting sick showed no signs of head wounds. By December 1914 as many as 10% of British officers and 4% of enlisted men were experiencing “nervous and mental shock”.
The term “shell shock” was coined during the Battle of Loos to reflect an assumed link between the symptoms and the effects of explosions from artillery shells. The term was first published in 1915 in an article in The Lancet by Charles Myers. Some 60–80% of shell shock cases displayed acute neurasthenia, while 10% displayed what would now be termed symptoms of conversion disorder, including mutism and fugue.
The number of shell shock cases grew during 1915 and 1916 but it remained poorly understood medically and psychologically. Some physicians held the view that it was a result of hidden physical damage to the brain, with the shock waves from bursting shells creating a cerebral lesion that caused the symptoms and could potentially prove fatal. Another explanation was that shell shock resulted from poisoning by the carbon monoxide formed by explosions.
In spite of this evidence, the British Army continued to try to differentiate those whose symptoms followed explosive exposure from others. In 1915 the British Army in France was instructed that:
Shell-shock and shell concussion cases should have the letter ‘W’ prefixed to the report of the casualty, if it was due to the enemy; in that case the patient would be entitled to rank as ‘wounded’ and to wear on his arm a ‘wound stripe’. If, however, the man’s breakdown did not follow a shell explosion, it was not thought to be ‘due to the enemy’, and he was to [be] labelled ‘Shell-shock’ or ‘S’ and was not entitled to a wound stripe.
2015 research by Johns Hopkins University has found that the brain tissue of combat veterans who have been exposed to improvised explosive devices (IEDs) exhibit a pattern of injury in the areas responsible for decision making, memory and reasoning. This evidence has led the researchers to conclude that shell shock may not only be a psychological disorder, since the symptoms exhibited by affected individuals from the First World War are very similar to these injuries. Immense pressure changes are involved in shell shock. Even mild changes in air pressure from weather have been linked to changes in behavior.
There is also evidence to suggest that the type of warfare faced by soldiers would affect the probability of shell shock symptoms developing. First-hand reports from medical doctors at the time note that rates of such conditions decreased once the war was mobilized again during the 1918 German offensive, following the 1916-1917 period where the highest rates of shell shock can be found. This could suggest that it was trench warfare, and the experience of siege warfare specifically, that led to the development of these symptoms.